hey everyone in cereth registered nurse Orion common in this video I want to be doing an in clicks review over osteo arthritis in this video is part of an ink Lux review series over the musculoskeletal system so be sure to check out those other videos and as always at the end of this YouTube video you can access the free quiz that will test you on oay so let's get started so what is osteoarthritis oay is the most common type of arthritis out of all the arthritis is such as like rheumatoid arthritis gout things like that and oh it develops due to the deterioration of the cartilage specifically that articular cartilage the Highland cartilage so remember that that's what makes us different then say rheumatoid arthritis that was where we had inflammation of that synovium the lining inside the joint so whenever you think of oay think of cartilage that's our problem so what is so special about this articular cartilage that hyaline cartilage well it plays a huge role in allowing us to move our joints without stiffness and pain and it's a rubbery smooth tissue and it's filmed at the end of the bones within a joint so here we have two bones coming together because that is what a joint is and at the end of the bone we have our Highland cartilage and that is that in this light brown and notice it's plentiful there's a lot of it it's nice and smooth we don't have any breaks in it so what does this cartilage do it acts as a protective mechanism by providing a slick surface for bones to slide and glide with movement right now I'm using my hyaline cartilage it's moving my arm and salão anit to move freely I don't have any pain or stiffness and it also absorbs shock during movement so let's take a closer look at a healthy joint with nice hyaline cartilage so we have our two bones coming together and around it we in this maroon color this is our joint capsule and within that capsule you have in the green the synovium and then you have inside the synovial fluid and then in light brown again is your hyaline cartilage and notice whenever you look at this this beautiful joint space there's a nice space in between our two bones they're not on top of each other now let's flip it around and let's look at a bone or a person that may have osteoarthritis okay notice what do you see right off the bat that joint space is literally almost gone and it's causing our bones to rub together well look there's no Highland cartilage present it's very very thin it's very miniscule down at the bottom and what's gonna happen is this is going to affect the inside of the bone and the outside of the bone because you have these bones rubbing up against each other grading on each other and we know just from common sense that we don't want bones grading on each other because when anything grades on itself you're going it's gonna break down so what's gonna happen or results we're gonna have grading of the bones okay you may hear a patient may report this grading film clicking noise we call it crepitus and this is from that decrease joint space now this is gonna lead to again outside bone changes where the patient is going to develop bone spurs bones formation technical term is called osteophytes and whenever we're going to be talking about diagnostic testing on the x-ray this is one thing that's going to be picked up you're gonna see this in oay compared to not seen it in rheumatoid arthritis that's one of the different different things you will find are those osteophytes in oay also the inside of the bone is going to experience sclerosis and this is where you're going to have abnormal hardening of that bone now another thing that can make things worse is that parts of that bone that's deteriorating and that cartilage that's breaking off can float around and that limited joint face that they already have and this can cause them even more pain and even more problems so some things signs and symptoms we want to remember and we want to remember that they are going to have some really hard bony joints okay instead of in rheumatoid arthritis remember those joints were soft they were swollen they were inflamed and red and worn here they're not going to be red and warm because with RA that was inflammation of the synovium they have systemic inflammation going on here our joints are really only affected it's not systemic because oay is due to overtime that wear and the tear on the joints which we're going to look at the risk factors here in here in a second they're also going to have the pain which is expected with those bones rubbing together and they're going to have severe stiffness and just like an RA they're gonna have morning stiffness but the big thing is that it's going to be less than 30 minutes in a way they can recover a little bit faster from their stiffness and another big thing that's different is that they're gonna have that crepitus that grading of the bones on upon one another okay now let's look at our key points to remember about osteoarthritis before we get into our pneumonic to remember the signs and symptoms and those nursing interventions okay this condition is also referred to as the genitive joint disease so if you hear that think Oh a and remember just to recap this is where we have decreased cartilage around those bones it doesn't deal with the synovium which is inflamed in rheumatoid arthritis so remember that and oay happens in worsens over time which is why we're seeing it in patients who are older age and it most commonly occurs in the hands the knees the hips and the spine and really it's really targeting those weight-bearing joints and why is that because your knees your hips your spine really takes a lot of stress on our body and over time it can wear out so it affects those joints another thing to remember that's very important that helps you know the difference between Oh a and RA is that this condition is not symmetrical so like an RA if it was in the right wrist it was gonna be in the left wrist and it's also not systemic so you're not going to see a fever with this the heart the lungs aren't going to be involved you're not gonna see anemia like how you do in rheumatoid arthritis so remember that unsymmetrical not systemic and risk factors for developing this again is older age 40 plus because it's the wear and tear disease over time that cartilage wears away also repeated joint injuries like if a patient and was a sports player played a lot of sports had a lot of repeated joint injuries they're at risk for developing this strenuous jobs such as nursing and why is that because we have a very hard laborious job we're on our feet for 12 hours shifts water nurses can struggle with osteoarthritis of the knees that cartilage wearing out around the knees so remember that any job that hasn't a person on their feet doing physical hard labor they're at risk for this also being overweight and that is because all that extra weight is really heavy on those weight-bearing joints the spine the knees and the hips and losing weight can really improve these patients quality of life and genetic factor as well now with osteoarthritis just like with rheumatoid arthritis there is no cure the damage that is done can't be reversed however the patient can improve their signs and symptoms which we're really going to talk about are nursing interventions like through exercise losing weight medications like injections of corticosteroids and that joint NSAIDs topical creams or surgery and in severe cases patients can be a candidate for surgery like one surgery is like a joint replacement where they can replace the hips or the knee another thing is a procedure like say they had osteo arthritis in their knee they can have a knee arthroscopy surgery and this is where they go in and remove those fragments of cartilage that have collected within that joint space and debris and smooth out that area and help improve symptoms another procedure they can do is called a bone realignment for instance say the patient has osteoarthritis in their knee they can get a procedure called a knee osteotomy and they will go in realign that affected me and this will actually help decrease the amount of weight on that affected knee so it can help prolong the need for a possible joint replacement in the future and help improve those signs and symptoms and help them have better mobility and it's typically used in the early stages of oay and patients are best candidates whenever they only have one side that is affected with oay now with diagnosing from nurse's standpoint you just want to be familiar with what the physician may order and things you have to watch out for because there's not really one conclusive test that can diagnose this they have to look at several things and as your role as a nurse you want to be assessing that patient for signs and symptoms and see asking yourself is this gout is this rheumatoid arthritis is this osteoarthritis and catching it early and reporting those signs and symptoms to the physician and sometimes physicians whenever the patient has those signs and symptoms will try to rule out other forms of arthritis by ordering tests to measure the joint to analyze the joint fluid to make sure does it have if it has uric acid in it it could be gout is the synovium inflames there are a lot of inflammation going on it could be rheumatoid arthritis it do they have a positive rheumatoid factor which is an RA again and another thing is they can order an x-ray and the x-ray will be helpful in looking at that joint space so what is the joint space going to look like again in a way it's going to be decrease so look at that also is there presence of bones for like those osteophytes and again this is conclusive with a you're not going to see that in our a and looking at that integrity of the bone is it experiencing sclerosis hardening as parts of it breaking off and unremember an x-ray only shows bones so you can't look at the cartilage so if you ever see on an exam x-ray assessing the cartilage x-rays don't can't see cartilage they only see bones so looking at those things together can help give the radiologist an idea if a a is present now let's look at the signs and symptoms of osteoarthritis and take all those key points that we learned together and put it in one pneumonic to help you remember the signs and symptoms and remember the word osteo because we're talking about osteoarthritis okay so oh for outgrow specifically bony outgrowths are going to be from these bone spur formations and with this disease you're gonna see these specific bony outgrowths on the hands and we have two types and I would remember these because any time as I always say my lectures you see people's names or a funny name remember that because it's probably gonna be on an exam okay so the two types of notes that you can find on the fingers of the hand are called herb endings and boast shards so let's talk about these okay first bouchard's okay so whenever you look at your hand we are talking about the middle joint and we're gonna talk about the top joint of the fingers this is where these notes can be located so bouchard's is going to be at the proximal inter phalangeal joint okay the proximal and how I remember this because sometimes you have to think of things to help you remember stuff is I look at my hand and I think of the alphabet bouchard starts with B and her Burdine starts with H so B comes before H so I know both shards is here and her burdens is there so bouchard's is going to be the proximal remember proximal is closest to you at that joint the middle joint and her burdens is going to be at that top finger joint the distal interphalangeal joint so that's how I remember that and that and this is how these nodes look here you will see in the black circles this is where both shards nodes are located at that proximal interphalangeal joint and notice the patrician the bony outgrowth coming out especially on that left hand and then in the red squares this is the harbor Dean's notes the distal interphalangeal joint where it's located at now as you can see on that right hand that there are those protrusions of those bony outgrowths next s for sunrise stiffness and this is going to be morning stiffness less than 30 minutes remember if it's greater than 30 minutes that is found in rheumatoid arthritis and the pain and the stiffness that these patients are going to experience is going to be worse at the end of the day and this is because they've been moving around using those knees using the hips and the spine and it's just overuse them okay next T for tenderness when touching the joint site with bony overgrowth so whenever you touch it those bony overgrowth those will be tender but you're not going to see warmth in a boggy soft site like how you would an RA that's another difference efore experiencing crepitus that's not grading whenever they're moving the bone and exercising it and this will cause pain with that whenever they're doing it but it'll actually go away when they stop it so that's another thing and then oh for only the joints only the joints are involved this is not systemic like with RA and those weight-bearing joints are going to be affected and it's not a requirement for this to be symmetrical like how an RA it affects the right wrist it's going to affect the left wrist in a way it can affect both joints or can just affect one it doesn't have to be symmetrical now let's look at our nursing interventions what are we going to do for this patient who has a a-okay first we are going to assess the patient for sign and symptoms every patient you have you want to look at their joint mobility you want to look for those suspicious signs and symptoms that we went over that they may have this condition and report it to the physician so we can catch this early and they can get treatment you're also going to assess their pain see how well they're managing their pain and see their perception of this disease how is it affecting their daily activities are they really depressed are they not able to do the things they weren't we're able to and help develop a plan on how they can manage us better physical therapy exercise exercise is very very effective in the treatment of osteoarthritis so you really want to stress that to your patient because they're really gonna look at you and say man I'm having a lot of pain I can't even think about exercising but you need to tell them that over time as you start out slow and gradually improve with exercising you're going to start having decreased stiffness improve mobility you're gonna start feeling better feeling like you can take control of your life again so what physical exercise is going to do it's going to increase their muscle strength it's going to help them lose weight if they're overweight is if that's why they have osteoarthritis will help them lose weight which is going to decrease the stress on those joints and it's going to improve the mental health which will all together decrease pain and increase mobility however if they have a painful joint that is irritating them like their knee is hurting or something like that they need to rest that joint until it's better so what types of exercises do they want to do and I would remember these types good type is low-impact which includes walking water aerobics or stationary bike riding anything that gives them cardiovascular improvement along with moving those joints but it's not aggressively having them pay on their feet on the ground which causes a lot of shock on those joints especially those knees and hips and spine also strength training like lifting weights that's going to improve their strength and their muscles and range of motion exercises which is going to improve mobility and decreased stiffness now exercises that they don't want to do they don't want to do high impact a lot of times some people think about exercising they think about running or jogging or something like that but that's what they want to avoid with osteoarthritis so no running no jogging no jump roping anything where two feet are going to be leaving the ground it can be really hard on those joints more nursing interventions include he in cold compresses over those sides physical therapy and occupational therapy they are very helpful in helping the patient with assistive devices figuring out what devices would be best for the patient and these devices can actually help decrease the stress on the joints so you want to make sure that your patient is using them correctly because they are at risk for safety issues they can fall and hurt themselves even worse so as a nurse you want to watch out for that and some assistive devices include like the raised toilet seats because whenever patients have osteoarthritis in the hips and they go to set down on a low toilet seat it's very hard for them to get that low those joints can lock up sometimes and it's especially hard to get off of to come out when the toilet solo another thing is getting the patient involved with other support groups of patients who have osteoarthritis so looking locally for that because they have exercise programs so these patients can exercise together and they know what they're going through because they both they all have the same conditions so helping just improve the mental health of your patient as well and educating them to structure their day so they don't overuse those joints take time to rest because you know when you're younger you could just do it all but now as you get older you got to take time to rest and that'll help decrease that pain and that stiffness that you feel at the end of the day also for patients who are overweight educating them you know you lose weigh and we can get your body mass index less than 25 that's going to make you feel better and decrease the amount of stress on those joints okay medications that can be used one thing is like those intra-articular injections is an injection within the joint of corticosteroids and what this is going to do is it's going to reduce the inflammation of those inflamed tendons and ligaments now this is temporary relief it usually lasts the most that can last is maybe like a month or two so they have to go get repeated injections and the oral corticosteroids aren't as effective in this because remember this is just within the joint in rheumatoid arthritis corticosteroids were prescribed because that helped because we have inflammation all over the body but injections are best with this condition another thing is glucosamine some studies have shown that it decreases the signs and symptoms and improves the function and pain relief they can take like insets however repeated long-term use of NSAIDs has been shown to affect cardiovascular health along with causing GI problems like GI bleeding so what tell the patient to watch out for dark black stools tal know they can take that which doesn't have the GI upset like the insides topical creams that they can rub on the site of the joint and controlled substances okay so that wraps up this in CLECs review over osteoarthritis thank you so much for watching don't forget to take the free quiz and to subscribe to our channel for more videos